By Thilo Kaltenbach, Morris Hosseini, Ulrich Kleipaß, Karsten Neumann, Oliver Rong and Sara Barada

Healthcare systems worldwide agree on the urgency of resilience—but consistently struggle to translate that consensus into funded priorities and practical readiness. Based on a survey of 486 senior experts across the healthcare value chain and a comparative country assessment, Roland Berger's eighth Future of Health study examines what resilience means in practice, where systems are falling short, and what governments, hospitals, insurers, and pharmaceutical and medtech companies can do to close the gap before the next disruption arrives.

Healthcare systems have always had to respond to change. What is different today is the scale of simultaneous pressures they face—and the way those pressures interact. Acute shocks such as pandemics, cyberattacks, and geopolitical conflicts increasingly overlap with chronic stressors including workforce shortages, demographic aging, and climate change. The question is no longer whether healthcare systems will be disrupted, but whether they are structured to withstand it. Roland Berger's eighth Future of Health study examines exactly this challenge—drawing on a survey of 486 senior experts across policymakers, payers, providers, and producers, and a comparative country assessment spanning multiple geographies.

Urgency is clear; strategy is not

The findings confirm broad and growing awareness of the challenge. Eighty-one percent of respondents say healthcare system resilience is becoming more important. The pattern holds across regions, though with variation: 86% of German respondents expect resilience to become more important, compared to 79% in Switzerland and 60% in Japan. At the same time, stakeholders are deeply divided on the strategic questions that would make resilience actionable in practice.

Five strategic trade-offs reveal where consensus breaks down. On the question of prevention versus affordability, 73% lean toward resilience-first investment—but insurers are a notable exception, with more than 40% favoring cost containment over proactive preparedness. On the balance between structured planning and flexible response, respondents are nearly evenly split. On public versus private responsibility, 60% favor primary public accountability—though the United States diverges, with a majority favoring greater private-sector responsibility. On national self-sufficiency versus international cooperation, and on central versus local control, responses are similarly divided. These divisions are not merely academic: they represent the strategic paralysis that currently prevents many healthcare systems from translating resilience awareness into resilience investment.

Where healthcare systems are most exposed

The study identifies eight major stressors across two categories. Acute shocks—natural catastrophes, health emergencies, geopolitical conflicts, and cyberattacks —compress all resilience demands into short timeframes. The COVID-19 pandemic disrupted essential services in 92% of countries surveyed by WHO. In 2023, 309 cybersecurity incidents targeted the EU health sector, with ransomware accounting for 54% of cases. Germany is currently evaluating whether its system could manage up to 1,000 seriously wounded soldiers per day in a large-scale military scenario—a question that exposes significant gaps in trauma capacity and logistics.

Chronic stressors—workforce shortages, demographic change, climate change, and unhealthy lifestyles—reshape system foundations over years and decades. Europe faces a projected shortfall of 4.1 million healthcare workers by 2030. The OECD old-age dependency ratio is forecast to rise from 31% in 2023 to 52% by 2060, significantly increasing demand for continuous and long-term care. WHO estimates that climate change could cause approximately 250,000 additional deaths per year between 2030 and 2050.

Respondents feel least prepared for the stressors they consider most important. Demographic change is the number one concern, followed by workforce shortages and geopolitical conflict. Not a single respondent considers their healthcare system fully equipped to manage geopolitical conflict risk.

Five competences that define resilient healthcare systems

Roland Berger's framework organizes resilience around five core competences that must operate continuously and reinforce one another. Anticipate: resilient systems maintain real-time intelligence and early warning capabilities connected to predefined decision authority. Respond: effective response depends on governance structures designed before a crisis, not improvised under pressure. Maintain: sustaining essential services during disruption is the most frequently cited competence in the academic literature—and the one most directly threatened by financing models optimized for throughput rather than preparedness. Recover: post-crisis care sequencing must be managed by clinical urgency, not by which services are most visible or profitable. Adapt: the highest-order competence requires cross-sector governance reform and updated incentive structures so that systems emerge from crises better equipped for the next one.

A fundamental structural problem runs across all five competences: no single actor has both the authority and the incentives to drive system-level resilience. Hospitals are seen as the primary operational actors, but activity-based financing rewards procedures—not preparedness. Governments hold the mandate but rarely ring-fence resilience funding. Insurers have the actuarial capabilities to support risk pooling, but current incentive structures do not reward this. Pharmaceutical and medtech companies are essential for supply security and medical countermeasures, but pricing and regulatory conditions must keep critical producers commercially viable in non-crisis periods.

The full study offers concrete, stakeholder-specific recommendations across all five competence areas—together with a comparative country assessment of how leading systems including Japan, Israel, Saudi Arabia, Sweden, Finland, and Germany are translating resilience investment into operational capability. For senior healthcare leaders, the study provides both the diagnostic framework and the practical roadmap needed to move from stated priority to working capability.

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